Cramer Holger, Haller Heidemarie, Lauche Romy, Steckhan Nico, Michalsen Andreas, Dobos Gustav
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany;
Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Berlin, Germany.
Am J Hypertens. 2014 Sep;27(9):1146-51. doi: 10.1093/ajh/hpu078. Epub 2014 May 2.
The aim of this systematic review and meta-analysis was to evaluate the quality of evidence and the strength of recommendation for yoga as a therapeutic means in the management of prehypertension and hypertension.
MEDLINE/Pubmed, Scopus, CENTRAL, and IndMED were screened through February 2014 for randomized controlled trials (RCTs) on the effects of yoga interventions (≥8 weeks) compared with usual care or any active control intervention on blood pressure in patients with prehypertension (120-139/80-89 mm Hg) or hypertension (≥140/≥90 mm Hg). Risk of bias was assessed using the Cochrane risk of bias tool; quality of evidence was assessed according to the GRADE recommendations.
Seven RCTs with a total of 452 patients were included. Compared with usual care, very low-quality evidence was found for effects of yoga on systolic (6 RCTs, n = 278; mean difference (MD) = -9.65 mm Hg, 95% confidence interval (CI) = -17.23 to -2.06, P = 0.01; heterogeneity: I (2) = 90%, χ(2) = 48.21, P < 0.01) and diastolic blood pressure (6 RCTs, n = 278; MD = -7.22 mm Hg, 95% CI = -12.83 to -1.62, P = 0.01; heterogeneity: I (2) = 92%, χ(2) = 64.84, P < 0.01). Subgroup analyses revealed effects for RCTs that included hypertensive patients but not for RCTs that included both hypertensive and prehypertensive patients, as well as for RCTs that allowed antihypertensive comedication but not for those that did not. More adverse events occurred during yoga than during usual care. Compared with exercise, no evidence was found for effects of yoga on systolic or diastolic blood pressure.
Larger studies are required to confirm the emerging but low-quality evidence that yoga may be a useful adjunct intervention in the management of hypertension.
本系统评价和荟萃分析的目的是评估将瑜伽作为治疗手段用于管理高血压前期和高血压的证据质量及推荐强度。
截至2014年2月，对MEDLINE/Pubmed、Scopus、CENTRAL和IndMED进行检索，查找关于瑜伽干预（≥8周）与常规护理或任何积极对照干预相比，对高血压前期（120 - 139/80 - 89 mmHg）或高血压（≥140/≥90 mmHg）患者血压影响的随机对照试验（RCT）。使用Cochrane偏倚风险工具评估偏倚风险；根据GRADE推荐评估证据质量。
纳入了7项RCT，共452例患者。与常规护理相比，发现瑜伽对收缩压（6项RCT，n = 278；平均差值（MD）= -9.65 mmHg，95%置信区间（CI）= -17.23至 -2.06，P = 0.01；异质性：I² = 90%，χ² = 48.21，P < 0.01）和舒张压（6项RCT，n = 278；MD = -7.22 mmHg，95% CI = -12.83至 -1.62，P = 0.01；异质性：I² = 92%，χ² = 64.84，P < 0.01）影响的证据质量极低。亚组分析显示，纳入高血压患者的RCT有效果，但纳入高血压和高血压前期患者的RCT以及允许联合使用抗高血压药物的RCT无效果，不允许联合使用抗高血压药物的RCT有效果。与常规护理相比，瑜伽期间发生的不良事件更多。与运动相比，未发现瑜伽对收缩压或舒张压有影响的证据。
需要开展更大规模的研究来证实瑜伽可能是高血压管理中一种有用的辅助干预措施这一尚不完善但质量较低的证据。
